Risk Factors For Cutaneous Leishmaniasis Research Articles

Geographical and climatic risk factors of cutaneous leishmaniasis in the hyper-endemic focus of Bam County in southeast Iran.

Cutaneous leishmaniasis (CL) is a prevalent debilitating disease in many countries, particularly in Iran, the Middle East, North Africa, and South America. Bam County is the most important highly endemic focus of anthropometric CL in Iran and has been under consideration by WHO. This study investigated the environmental and geographic factors affecting the occurrence and distribution of CL in this focus. Demographic data and the home addresses of CL patients diagnosed from 2015 to 2020 were retrieved from the Leishmaniasis Center of Bam in southeast Iran. The effects of mean annual rainfall (MAR), mean annual humidity (MAH), mean annual temperature (MAT), maximum annual temperature (MaxMAT), minimum annual temperature (MinMAT), mean annual humidity (MAH), mean annual evaporation (MAE), mean annual frosty days (MAFD), mean annual snowy hours (MASH), elevation, and land cover on the distribution of CL were analyzed using geographical information systems (GIS) and univariate and multivariate regression models. Of 847 patients studied, 50.9% (n = 431) were female and 49.1% (n = 416) were male. The age classes 0-10 (n = 246) and 11-20 (n = 145) showed the highest frequency of patients, respectively. Leishmaniasis patients were reported from 66 villages/cities (11.8%) out of 561 residential areas in Bam County. Univariate analysis showed that urban settings (OR = 21.66), agriculture (OR = 5.73), orchards (OR = 5), salty land (OR = 1.05), and temperatures (OR = 2.37, 2.79 and 3.47) had positive effects on CL occurrence (p < 0.05), while altitude, precipitation, humidity, evaporation, and the number of frozen days had negative effects. Multivariate analysis identified urban settings (OR = 13.6), orchards (OR = 6.29), agriculture (OR = 5.82), and minimum temperature (OR = 2.38) as the most significant determinants of CL occurrence in this region. Environmental and ecological factors play an important role in the distribution of CL in Bam County. The high-risk zones for CL are cities/large villages, agricultural and orchard areas in lower altitudes and with warmer climates and lower rainfall and humidity. This model can guide researchers and health managers to properly conduct CL control programs and allocate budgets.

A disfiguring neglected tropical disease sweeps war-torn Yemen: a community-based study of prevalence and risk factors of cutaneous leishmaniasis among rural communities in the western highlands.

Cutaneous leishmaniasis (CL) is a major health problem in Yemen and is endemic in many rural areas across the country. A community-based cross-sectional survey followed by unmatched case-control comparisons was conducted among 612 participants in Utmah district, western Yemen. A total of 223 participants were included in the case-control analysis to identify the significant risk factors. Skin scrapping samples were examined by microscopy and internal transcribed spacer 1 nested polymerase chain reaction. Overall, 33% (202/612) of the participants had active skin lesions and/or scars that met the clinical criteria for CL. A total of 90 (14.7%) participants had suspected active CL lesions; however, a prevalence of 8.7% (53/612) was obtained based on molecular and parasitological examination, with Leishmania tropica being the only causative agent identified. Multivariable logistic regression analyses showed that being ≤10y old, being female, living in houses with cracked walls, living in the presence of other family members with typical ulcerating skin diseases and sleeping outside were factors significantly associated with an increased likelihood of having CL. Moreover, keeping livestock on the ground floor of the house was significantly associated with a decreased likelihood of having CL. The study reveals an alarmingly high prevalence of CL among the studied population. Therefore there is an urgent need for effective control measures and improved treatment efforts against this devastating disease.

Cutaneous Leishmaniasis: Associated Risk Factors and Prevention in Hubuna, Najran, Saudi Arabia.

Many countries are currently affected by leishmaniasis, and cutaneous leishmaniasis is ranked among the ten most neglected diseases. The aim of this study was to determine the risk factors related to cutaneous leishmaniasis and preventive measures among people living in Hubuna, Najran, Saudi Arabia. A community-based cross-sectional survey was conducted from January to October 2022. A convenience sampling technique was used, with 396 individuals invited to participate in the current study and 391 included. A self-administered questionnaire was utilized for collecting data. Descriptive analysis was used for risk factors and preventive measures, while χ2 tests were used for determining associations with risk factors. Among participants, 38.1% (n=149) reported having cutaneous leishmaniasis clinically diagnosed and under treatment. Age 0-10 years was found to be associated significantly with cutaneous leishmaniasis infection (AOR 3.08, 95% CI 1.6-6.4; P=0.002) compared to other groups. A significant association was noted too for those residing in/around planted areas versus those who were not (AOR 1.18, 95% CI 0.13-2.24; P<0.001). In terms of occupation, farming was significantly associated with cutaneous leishmaniasis (AOR 2.54, 95% CI 1.15-3.76; P=0.010). No significant associations were observed in regard to sex (AOR 1.4, 95% CI 0.7-1.6; P=0.11), education (P=0.072), or preventive measures used (P>0.05). The cutaneous leishmaniasis endemicity level in Hubuna was high. Several socioeconomic and environmental factors contribute enormously to the spread of the disease in the area. Further investigation of risk factors of cutaneous leishmaniasis all over the country and setting up appropriate interventions to prevent its spread are recommended.

Burden and risk factors of cutaneous leishmaniasis in Ethiopia: a systematic review and meta-analysis.

Cutaneous leishmaniasis (CL) is a major public health problem in Ethiopia. About 30 million people are at risk, and there are 20,000 to 50,000 new cases annually. It is maintained by rock hyraxes and Phlebotomus sand flies. Different studies showed the presence and risk factors of CL. However, there is no study on the pooled prevalence and risk factors. This study aimed to determine the pooled prevalence and risk factors of CL in Ethiopia. We retrieved published articles from different databases. The review was conducted based on PRISMA guidelines. The meta-analysis was done with Stata software version 14. The forest plot with random-effect model and inverse variance index was used to estimate the pooled prevalence with 95% confidence interval and heterogeneity of articles, respectively. A total of 99,226 people from 19 studies were screened. The overall pooled prevalence of CL was 20.4% with 95% CI (15.67-25.13%). The pooled prevalence is a weighted average of results of the included 19 studies. Highest pooled prevalence, 65.39% (95% CI: 61.14-69.47%), was in Southern Nations, Nationalities and Peoples' Region (SNNPR), and the lowest was 1.53% (95% CI: 1.43-1.63%) in Amhara Region. Children were the most affected age group. Living in a home close to farmlands, outdoor sleeping behavior, the presence of gorge, hyrax, cracked walls, animal dung, and other cases in the neighborhood were identified as risk factors for CL. There is high burden of CL in Ethiopia. Larger surveys are required. Health education on the prevention and control strategies shall be implemented.

Tissue inhibitor of metalloproteinase-1 (TIMP-1) serum level and genetic polymorphisms associated with cutaneous leishmania infections

IntroductionCutaneous leishmaniasis is considered a parasitic contagion resulting from the flagellated parasite belonging to the genus of Leishmania. Also, cutaneous leishmaniasis is a zoonotic ailment transmitted through the bloodsucking sand-flies bite (belonging to the Phlebotomus genus). The disease's reservoirs included wild or semi-domesticated animals, in general rodents and dogs. Tissue inhibitor metalloproteinase-1 (TIMP-1) is one of the extracellular matrix proteins that have a role in vessel wall degeneration and aneurysm development. In addition, it belongs to the zinc-dependent endopeptidases family that are involved in the degradation of connective tissues proteins which are included in vascular integrity maintenance. The Genetic deviations in the TIMP-1 genes might impact their expression at the transcription level or the enzyme activity. Therefore, the present study aimed to detect the impact of TIMP-1 serum level and single nucleotide polymorphisms (SNPs) rs41454248 and rs1043428 among the cutaneous leishmaniasis patients’ group compared to the control group. SubjectsSeventy-five cutaneous leishmaniasis patients (39 males and 36 females) with the age mean 23.91 ± 13.14 years participated in this study, compared to the matched number, age, and gender of a healthy control group (75: 38 males and 37 females) with the age mean 22.84 ± 4.35 years. In the current study, the serum level of TIM-1 and rs41454248 and rs1043428 SNPs were studied among the cutaneous leishmaniasis patients’ group compared to the control group. ResultsThe findings of the TIMP-1 level referred to a significant decrease among the cutaneous leishmaniasis patients’ group compared to the healthy control group (26339.67 ± 900.79 vs. 33480.25 ± 1098.63). Such, the rs41454248 SNPs findings referred that the GG genotype and G allele were non-significantly increased frequency percentage in cutaneous leishmaniasis patients group compared to the healthy control group (29.33 vs. 18.67%, OR: 1.81, p = 0.180; 55.0 vs. 47.0%, OR: 1.38, p = 0.204 respectively). Also, the high OR value of GG genotype and G allele referred to this genotype and allele might be a risk factor for cutaneous leishmaniasis. Likewise, the findings of rs1043428 SNPs appeared that the CC genotype and C allele were significantly increased frequency percentage in cutaneous leishmaniasis patients' group compared to the control group (37.33 vs. 4.0%, OR: 14.30, p = 3.6 × 10−7; 57.0 vs. 21.33, OR: 4.82, p = 4.5 × 10−10). Also, the high OR value of CC genotype and C allele referred to this genotype and allele might be risk factors for cutaneous leishmaniasis. In addition, the CG genotype appeared a non-significant increased frequency percentage in the patients' group compared to the control group and the value of OR referred to might be a risk factor for cutaneous leishmaniasis (33.33 vs. 25.33, OR: 1.47, p = 0.370). In addition, the serum level of TIMP-1 with the rs41454248 was significantly decreased in GA and AA genotypes of the patients’ group compared to the control. While the level was non-significantly decreased in the GG genotype of the patients' group compared to the control group. Likewise, the level of TIMP-1 with the rs1043428 was non-significantly decreased in all genotypes (except TT genotype) of the patients' group compared to the control. Whereas, a significant decrease level was appeared in the TT genotype of the patients' group compared to the healthy control group. ConclusionThe current findings demonstrated a significant association between TIMP-1 serum level and genetic polymorphisms (rs1043428 and rs41454248) among cutaneous leishmaniasis patients.

Evaluation of Household Preparedness and Risk Factors for Cutaneous Leishmaniasis (CL) Using the Community Assessment for Public Health Emergency Response (CASPER) Method in Pakistan.

(1) Background: In endemic areas of Pakistan, local community knowledge and attitudes towards cutaneous leishmaniasis (CL) are critical elements in the effective control and management of the disease. A cross-sectional epidemiologic design was used to assess the disease concern, preparedness, practices, and preventive behavior of the households and to assist the personnel and health care professionals in strengthening their planning efforts and awareness of CL. (2) Methods: A two-stage cluster sampling process, i.e., Community Assessment for Public Health Emergency Response (CASPER) was conducted from September 2020 to March 2021 on present household-level information about community needs and health status regarding CL in a cost-effective, timely, and representative manner. (3) Results: In the current study, 67% of the respondents were aware of CL and its causative agent and showed a low level of pandemic preparedness. The majority (74%) of the respondents mentioned that they did not avoid sandfly exposure areas. The majority (84%) of respondents had unsatisfactory behavior towards using bed nets, sprays, or repellents. (4) Conclusion: In endemic areas of Pakistan, the inadequate concern and low preparedness of the local community toward CL are critical aspects in efficient control and management of the disease.

Characterization of sand fly breeding sites in district Malakand, Khyber Pakhtunkhwa, Pakistan, and evaluation of risk factors for cutaneous leishmaniasis in the region.

Present study was carried to determine the sand fly species composition, breeding sites ecology, seasonal abundance, and spatial distribution in district Malakand, Khyber Pakhtunkhwa, Pakistan. In addition, risk factors associated with cutaneous leishmaniasis (CL) were also evaluated. Survey of indoor and outdoor habitats was carried out using sticky traps in 31 villages of Dargai and Batkhela tehsils of Malakand. Soil from habitats of adult and immature sand flies was analysed. Questionnaire-based household survey was also performed in these villages to assess risk factors associated with CL. Soil samples from selected CL positive households were analysed for its contents. Additionally, clinicoepidemiological data from local health centres was examined for the year 2019. Total of 3,140 sand flies belonging to 18 species were collected. Phlebotomus sergenti was the most abundant species (38.16%). Its abundance had a strong positive correlation with mean monthly relative humidity and negative correlation with average temperature. Phlebotomus sergenti and Phlebotomus papatasi were abundant at an elevation ranging from 320 to 1,120m above sea level and in agricultural lands near human settlements. Flight height preference apparatus collected maximum sand flies at 30cm (1ft) above the ground and all species associated negatively with height. Soil analysis from habitats of adult and immature flies showed that highest mean number of adults and immatures were recorded from silt loam which carried highest concentrations of K2 O, Mg, Ca, and Zn. Number of immature sand flies correlated moderately (r=.7, p<.05) with K2 O soil concentrations. There was significant similarity between organic matter contents in soil samples from positive breeding sites and CL households (Wilcoxon rank-sum test, p=.1976). In multivariate analysis model for CL risk factors, age (26-35 and >35years), knowledge of leishmaniasis, living in a middle and upper class, preachers visit to villages, and assumption that Afghan refugees are more prone to CL were significant. CL patient's archived data from health centres showed that majority of patients had lesions on face and hands. Patient's influx was highest in February and March.

Risk factors for cutaneous leishmaniasis in a high-altitude forest region of Peru

BackgroundAmerican cutaneous leishmaniasis (CL) is a neglected tropical disease typically associated with men working in remote, sylvatic environments. We sought to identify CL risk factors in a highly deforested region where anecdotal reports suggested an atypical proportion of women and children were infected with CL raising concern among authorities that transmission was shifting towards domestic spaces and population centers.MethodsWe describe the characteristics of CL patients from four participating clinics after digitizing up to 10 years of patient data from each clinic’s CL registries. We assessed risk factors of CL associated with intradomestic, peridomestic, or non-domestic transmission through a matched case-control study with 63 patients who had visited these same clinics for CL (cases) or other medical reasons (controls) between January 2014 and August 2016. The study consisted of an in-home interview of participants by a trained field worker using a standard questionnaire. Risk factors were identified using bivariable and multivariable conditional logistic regression.ResultsBetween 2007 and 2016, a total of 529 confirmed CL positives were recorded in the available CL registries. Children and working aged women made up 58.6% of the cases. Our final model suggests that the odds of sleeping in or very near an agricultural field were five times greater in cases than controls (p = 0.025). Survey data indicate that women, children, and men have similar propensities to both visit and sleep in or near agricultural fields.ConclusionsWomen and children may be underappreciated as CL risk groups in agriculturally dependent regions. Despite the age-sex breakdown of clinical CL patients and high rates of deforestation occurring in the study area, transmission is mostly occurring outside of the largest population centers. Curbing transmission in non-domestic spaces may be limited to decreasing exposure to sandflies during the evening, nighttime, and early morning hours. Our paper serves as a cautionary tale for those relying solely on the demographic information obtained from clinic-based data to understand basic epidemiological trends of vector-borne infections.

Classification of cutaneous leishmaniasis patients based on its risk factors using latent class analysis.

Cutaneous leishmaniasis is one of the main health-economic problems around the world. Data were collected from all patients with cutaneous leishmaniasis referred to the health centres of Kermanshah province between 2013 and 2019. Latent class analysis was conducted by PROC LCA in SAS 9.2 and a significant level was set at 0.05. Four latent classes were identified: low (33.8%), moderate (9.8%), high (22.4%) and very high risk (34.0%). The probability of having a travel history was high in the third class. Our study indicated that having history of an eschar has no role in the classification of patients. On the other hand, a positive smear test is important in classifying subjects. Our results indicate that more than half of all patients fell under high risk or very high-risk class. This emphasises the importance of planning preventive intervention by considering different risk factors of cutaneous leishmaniasis simultaneously.

A Genome-wide Association Study Identifies SERPINB10, CRLF3, STX7, LAMP3, IFNG-AS1, and KRT80 As Risk Loci Contributing to Cutaneous Leishmaniasis in Brazil.

BackgroundOur goal was to identify genetic risk factors for cutaneous leishmaniasis (CL) caused by Leishmania braziliensis.MethodsGenotyping 2066 CL cases and 2046 controls using Illumina HumanCoreExomeBeadChips provided data for 4 498 586 imputed single-nucleotide variants (SNVs). A genome-wide association study (GWAS) using linear mixed models took account of genetic diversity/ethnicity/admixture. Post-GWAS positional, expression quantitative trait locus (eQTL) and chromatin interaction mapping was performed in Functional Mapping and Annotation (FUMA). Transcriptional data were compared between lesions and normal skin, and cytokines measured using flow cytometry and Bioplex assay.ResultsPositional mapping identified 32 genomic loci associated with CL, none achieving genome-wide significance (P < 5 × 10−8). Lead SNVs at 23 loci occurred at protein coding or noncoding RNA genes, 15 with eQTLs for functionally relevant cells/tissues and/or showing differential expression in lesions. Of these, the 6 most plausible genetic risk loci were SERPINB10 (Pimputed_1000G = 2.67 × 10−6), CRLF3 (Pimputed_1000G = 5.12 × 10−6), STX7 (Pimputed_1000G = 6.06 × 10−6), KRT80 (Pimputed_1000G = 6.58 × 10−6), LAMP3 (Pimputed_1000G = 6.54 × 10−6), and IFNG-AS1 (Pimputed_1000G = 1.32 × 10−5). LAMP3 (Padjusted = 9.25 × 10−12; +6-fold), STX7 (Padjusted = 7.62 × 10−3; +1.3-fold), and CRLF3 (Padjusted = 9.19 × 10−9; +1.97-fold) were expressed more highly in CL biopsies compared to normal skin; KRT80 (Padjusted = 3.07 × 10−8; −3-fold) was lower. Multiple cis-eQTLs across SERPINB10 mapped to chromatin interaction regions of transcriptional/enhancer activity in neutrophils, monocytes, B cells, and hematopoietic stem cells. Those at IFNG-AS1 mapped to transcriptional/enhancer regions in T, natural killer, and B cells. The percentage of peripheral blood CD3+ T cells making antigen-specific interferon-γ differed significantly by IFNG-AS1 genotype.ConclusionsThis first GWAS for CL identified multiple genetic risk loci including a novel lead to understanding CL pathogenesis through regulation of interferon-γ by IFNG antisense RNA 1.

Burden and risk factors of cutaneous leishmaniasis in a peri-urban settlement in Kenya, 2016.

Cutaneous leishmaniasis is a neglected disease known to cause significant morbidity among the poor. We investigated a suspected outbreak to determine the magnitude of cases, characterize the cases and identify risk factors of cutaneous leishmaniasis in Gilgil, a peri-urban settlement in Central Kenya. Hospital records for the period 2010-2016 were reviewed and additional cases were identified through active case search. Clinical diagnosis of cutaneous leishmaniasis was made based on presence of ulcerative, nodular or papular skin lesion. The study enrolled 58 cases matched by age and neighbourhood to 116 controls in a case control study. Data was collected using structured questionnaires and simple proportions, means and medians were computed, and logistic regression models were constructed for analysis of individual, indoor and outdoor risk factors. Of the 255 suspected cases of cutaneous leishmaniasis identified, females constituted 56% (142/255) and the median age was 7 years (IQR 7-21). Cases occurred in clusters and up to 43% of cases originated from Gitare (73/255) and Kambi-Turkana (36/255) villages. A continuous transmission pattern was depicted throughout the period under review. Individual risk factors included staying outside the residence in the evening after sunset (OR 4.1, CI 1.2-16.2) and visiting forests (OR 4.56, CI 2.04-10.22). Sharing residence with a case (OR 14.4, CI 3.8-79.3), residing in a thatched house (OR 7.9, CI 1.9-45.7) and cracked walls (OR 2.3, CI 1.0-4.9) were identified among indoor factors while sighting rock hyraxes near residence (OR 5.3, CI 2.2-12.7), residing near a forest (OR 7.8, CI 2.8-26.4) and having a close neighbour with cutaneous leishmaniasis (OR 6.8, CI 2.8-16.0) were identified among outdoor factors. We identify a large burden of cutaneous leishmaniasis in Gilgil with evidence of individual, indoor and outdoor factors of disease spread. The role of environmental factors and rodents in disease transmission should be investigated further.

FLI1 gene influences lesion size and skin test may predict therapeutic response in cutaneous leishmaniasis.

Genes associated with wound healing have been shown to be risk factors for cutaneous leishmaniasis (CL) which is caused by Leishmania braziliensis. In this study, we examined whether the genes previously associated with CL influenced the clinical outcome. Patients were genotyped and retrospectively classified as responders, who were cured with a single course of pentavalent antimony (Sbv), or as refractories, who did not respond to Sbv. Patients characterised as responders showed a stronger response to the leishmanin skin test (LST) when compared to the refractory subjects (p = 0.0003). Furthermore, we observed an association between the FLI1 CC genotype and an increased size of ulcers (p = 0.0170). We suggest that the leishmanin skin test may be a predictive tool for therapeutic outcome and reinforce FLI1 as a potential influencer of susceptibility and lesion size in CL.

Risk factors for cutaneous leishmaniasis in the rainforest of Bolivia: a cross-sectional study

BackgroundCutaneous leishmaniasis (CL) is an endemic disease in Bolivia, particularly in the rainforest of Cochabamba, in the municipality of Villa Tunari. The precarious, dispersed, and poorly accessible settlements in these farming communities make it difficult to study them, and there are no epidemiological studies in the area. The aim of the present study was to identify the risk factors associated with cutaneous leishmaniasis.MethodsA cross-sectional study was conducted in August 2015 and August 2016 in two communities of Villa Tunari, Cochabamba. The cases were diagnosed through clinical examinations, identification of the parasite by microscopic examination, and the Montenegro skin test. Risk factors were identified through logistic regression.ResultsA total of 274 participants (40.9% female and 59.1% male) were surveyed, of which 43% were CL positive. Sex was the only factor associated with CL with three times more risk for men than for women; this finding suggests a sylvatic mechanism of transmission in the area.ConclusionsIt is advisable to focus on education and prevention policies at an early age for activities related to either leisure or work. Further research is needed to assess the influence of gender-associated behavior for the risk of cutaneous leishmaniasis.

Risk factors of Cutaneous Leishmaniasis (CL) caused by L. tropica: a case-control study in Palestine

Risk factors of Cutaneous Leishmaniasis (CL) caused by L. tropica: a case-control study in Palestine

Spatial modeling of cutaneous leishmaniasis in the Andean region of Colombia.

The objective of this research was to identify environmental risk factors for cutaneous leishmaniasis (CL) in Colombia and map high-risk municipalities. The study area was the Colombian Andean region, comprising 715 rural and urban municipalities. We used 10 years of CL surveillance: 2000-2009. We used spatial-temporal analysis - conditional autoregressive Poisson random effects modelling - in a Bayesian framework to model the dependence of municipality-level incidence on land use, climate, elevation and population density. Bivariable spatial analysis identified rainforests, forests and secondary vegetation, temperature, and annual precipitation as positively associated with CL incidence. By contrast, livestock agroecosystems and temperature seasonality were negatively associated. Multivariable analysis identified land use - rainforests and agro-livestock - and climate - temperature, rainfall and temperature seasonality - as best predictors of CL. We conclude that climate and land use can be used to identify areas at high risk of CL and that this approach is potentially applicable elsewhere in Latin America.

Assessing Incidence Patterns and Risk Factors for Cutaneous Leishmaniasis in Peshawar Region, Khyber Pakhtunkhwa, Pakistan.

Pakistan faces critical challenges pertaining to cutaneous leishmaniasis (CL), where it's distribution is more or less patchy. The goal of this study was to assess the incidence of CL as well as to identify potential risk factors in Peshawar region, Khyber Pakhtunkhwa, Pakistan. The study was conducted in the dermatology outpatient unit at Kuwait Teaching Hospital, Peshawar, Khyber Pakhtunkhwa, Pakistan. Longitudinal out-patient department visit data for 9,631 CL patients spanning a 42-mo (April 2011-October 2014) period was analyzed using autoregressive integrated moving average (ARIMA) time series models ARIMA(1,0,0)(0,1,0)12 and ARIMA(0,0,0)(0,1,0)12. The ARIMA concluded that the number of patients was increasing over time. Over the duration, frequency of male patients (58.2%) was higher. The mean age of CL patients was 16.4 (confidence interval = 16.14-16.70) yr and the majority of the patients were aged 5-20 yr (52.6%). Inflow of CL patients peaked close to February and March, followed by a decline until its lowest point in the months of August and September (P < 0.001). Two hundred individuals, including 88 cases and 112 controls, were matched by gender and age categories (<5, 5-20, >20 yr) to derive 63 matched pairs. Using univariate conditional logistic regression analyses of the matched pairs, we found that living in congested rooms (>6 persons), having family members with lesions (active/scars), keeping cattle inside dwellings at night, and having in-door vegetation were established as factors that significantly increased the risk of CL. On the other hand, living in houses constructed with bricked walls or wooden roofs (thatched/beam), ownership of treated bed nets, and having meshed windows were proven to be protective against CL. It was evident that the disease incidence has been on a gradual rise over the past few years. It was concluded that household clustering, house construction, and conventional behavioral practices (living with cattle) greatly impact the epidemiology of CL in the region. Conclusions from this study have significant implications for prospective control programs.

Risk factors for cutaneous leishmaniasis in Cukurova region, Turkey

We conducted a case-control study to evaluate risk factors for cutaneous leishmaniasis caused by Leishmania infantum outbreaks in villages in the Cukurova region, South Anatolia, Turkey. 282 respondents from eight villages were interviewed using structured questionnaires. Epidemiological and clinical characteristics, personal protection and knowledge of leishmania were analyzed. Young people, aged from 5–19 years, were found to be the most endangered group of villagers. The concurrent presence of both lesions and scars in nine persons may indicate repeated infections. Sleeping without bed nets, ownership of a dog and cattle ownership (living close to a barn and storage of dried dung according univariate analyses) were associated with a significantly increased risk of leishmania infection. Non-impregnated bed nets provided only partial protection, but their use decreased the risk approximately 1.6 times. Further research on the role of dogs in the transmission cycle and the effect of suitable interventions are needed to design the best strategy for disease control. Results suggest that personal protection should be increased, particularly among outdoor sleepers, with insecticide-treated bed nets suggested as the best choice.

Spatial analysis of eco-environmental risk factors of cutaneous leishmaniasis in Southern Iran

Background:Despite the advances in the diagnosis and treatment of leishmaniasis, it is still considered as a severe public health problem particularly in developing countries and a great economic burden on the health resources. The present study was designed and conducted to determine the eco-environmental characteristics of the leishmaniasis disease by spatial analysis.Materials and Methods:In an ecological study, data were collected on eco-environmental factors of Fars province in Iran and on cutaneous leishmaniasis (CL) cases from 2002 to 2009. geographic weighted regression (GWR) was used to analyse the data and compare them with ordinary least square (OLS) regression model results. Moran's Index was applied for analysis of spatial autocorrelation in residual of OLS. P value less than 0.05 was considered as significant and adjusted R2 was used for model preferences.Results:There was a significant spatial autocorrelation in the residuals of OLS model (Z=2.45, P=0.014). GWR showed that rainy days, minimum temperature, wind velocity, maximum relative humidity and population density were the most important eco-environmental risk factors and explained 0.388 of the associated factors of CL.Conclusion:Spatial analysis can be a good tool for detection and prediction of CL disease. In autocorrelated and non-stationary data, GWR model yields a better fitness than OLS regression model. Also, population density can be used as a surrogate variable of acquired immunity and increase the adjusted R2.

Environmental Risk Factors for the Incidence of American Cutaneous Leishmaniasis in a Sub-Andean Zone of Colombia (Chaparral, Tolima)

Environmental risk factors for cutaneous leishmaniasis were investigated for the largest outbreak recorded in Colombia. The outbreak began in 2003 in Chaparral, and in the following five years produced 2,313 cases in a population of 56,228. Candidate predictor variables were land use, elevation, and climatic variables such as mean temperature and precipitation. Spatial analysis showed that incidence of cutaneous leishmaniasis was higher in townships with mean temperatures in the middle of the county's range. Incidence was independently associated with higher coverage with forest or shrubs (2.6% greater for each additional percent coverage, 95% credible interval [CI] = 0.5-4.9%), and lower population density (22% lower for each additional 100 persons/km(2), 95% CI = 7-41%). The extent of forest or shrub coverage did not show major changes over time. These findings confirmed the roles of climate and land use in leishmaniasis transmission. However, environmental variables were not sufficient to explain the spatial variation in incidence.

Risk factors for onset of cutaneous and mucocutaneous leishmaniasis in Bolivia.

A survival analysis was performed on data from an endemic area of Bolivia where two populations, natives and highland migrants, were living, to investigate risk factors for onset of cutaneous leishmaniasis (CL) and its mucosal form (MCL). In a first data set (703 subjects with 242 CL patients), significant risk factors for CL were gender, native/migrant status, activity, and home-forest distance. The instantaneous risk of CL increased until adolescence in both populations, and rapidly decreased thereafter. This risk was 3-10 times higher in migrants than in natives until 20 years of age, and became similar thereafter. Environmental and behavioral factors did not seem sufficient to explain this contrast between the two populations, and this evolution with age may suggest differences in the mechanisms involved in the development of individual protection during childhood. In a second data set (446 CL patients with 34 mucosal forms) the native/migrant status was the main factor associated with the onset of mucosal form.